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Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: A 'New Health Technology' assessment in South Korea

Title
Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: A 'New Health Technology' assessment in South Korea
Authors
Kwon S.-H.Joo Y.-I.Kim S.H.Lee D.H.Baek J.-H.Chung S.S.Shin J.-Y.Eun C.S.Kim N.K.
Ewha Authors
정순섭
SCOPUS Author ID
정순섭scopus
Issue Date
2021
Journal Title
Annals of Surgical Treatment and Research
ISSN
2288-6575JCR Link
Citation
Annals of Surgical Treatment and Research vol. 101, no. 3, pp. 167 - 180
Keywords
Colorectal neoplasmsLaparoscopic total mesorectal excisionMeta-analysisSystematic reviewTransanal total mesorectal excision
Publisher
Korean Surgical Society
Indexed
SCIE; SCOPUS; KCI WOS scopus
Document Type
Article
Abstract
Purpose: Under the South Korea's unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as 'New Health Technology,' then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee. Methods: We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes. Results: Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11-0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures. Conclusion: Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a 'New Health Technology' endorsed by NECA in South Korea. © 2021, the Korean Surgical Society.
DOI
10.4174/astr.2021.101.3.167
Appears in Collections:
의과대학 > 의학과 > Journal papers
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